Emerging diseases in Bangladesh: Current microbiological research perspective

Molecular characteristics and antimicrobial resistance profiles of Staphylococcus aureus isolates from burns

BACKGROUND

Burns are a problem that affects millions of individuals around the world.

OBJECTIVE

This research aimed to analyze the genetic characteristics and antibiotic resistance of Staphylococcus aureus strains isolated from patients with burns. Identifying the genetic variations of three local strains of Staphylococcus aureus isolated from burns.

MATERIALS AND METHODS

Swab samples were collected from eighty sources (burns). Using sterile swabs containing media collected from patients treated at Baqubah Teaching Hospital between July 2022 and the end of September 2022, these samples were then cultured on blood agar and brain heart infusion agar. A total of twenty-four hours were spent incubating the cultured samples in an aerobic environment at 37 °C. During this time, isolated growing colonies showed characteristic growth, color, and hemolysis, while suspicious colonies were cultured for further identification.

RESULTS

Our results indicated the presence of several polymorphisms that were distributed in the investigated samples. However, almost all observed variations were concentrated only in the S2 isolates. The construction of phylogenetic trees confirmed this notion by positioning these S2-based amplicons to distinct categories within Staph. aureus organisms. Furthermore, the phylogenetic tree offered additional tools for the guaranteed identity of the samples that were analyzed. Consequently, the utilization of the PCR-sequencing approach in three DNA samples belonging to these local bacterial isolates has resulted in the confirmation of the identity of this strain. However, particular emphasis should be placed on S2 isolate as it has special variants that differ from its mates, in terms of its metabolic as well as phylogenetic consequences. Therefore, S2 isolates may represent a new strain that requires a whole genome sequencing strategy to validate its identity within Staph. aureus organisms. S.aureus resistance was 100% (Augmentin and Tetracycline), and 90% (Azithromycin and Trimethoprim), while Cefotaxime and Chloramphenicol recorded (75%, and 85%) respectively.

A critical look at synergies and fragmentations of universal health coverage, global health security, and health promotion in delivery of frontline health care services: A case study of Bangladesh

Universal Health Coverage (UHC) and Global Health Security (GHS) activities encompass mitigation of risks to health and well-being rights posed by infectious disease outbreaks and facilitated by health promotion (HP) activities. This case study investigated Bangladesh's readiness and capacity to 'prevent, detect and respond' to such outbreaks of an epidemic/pandemic nature. A rapid review of relevant documents, key informant interviews with policymakers/practitioners, and a deliberative dialogue with a crisscross of stakeholders were used to identify challenges and opportunities for 'synergy' among these streams of activities. Findings reveal conceptual ambiguity among respondents about the scope of the three `agendas and their inter-linkages. They perceived the synergy between UHC and GHS superfluous and were obsessed with losing their respective constituencies and resources. Poor coordination among the focal agencies in field activities, lack of supporting infrastructure, and shortage of human and financial resources posed additional challenges for better pandemic/epidemic preparation in future.

Funding

This study, "Researching the UHC-GHS-HP Triangle in Bangladesh," was funded by the Wellcome Trust, UK.

Disease-specific distress healthcare financing and catastrophic out-of-pocket expenditure for hospitalization in Bangladesh

Background

Financial risk protection and equity are two fundamental components of the global commitment to achieve Universal Health Coverage (UHC), which mandates health system reform based on population needs, disease incidence, and economic burden to ensure that everyone has access to health services without any financial hardship. We estimated disease-specific incidences of catastrophic out-of-pocket health expenditure and distress financing to investigate progress toward UHC financial risk indicators and investigated inequalities in financial risk protection indicators by wealth quintiles. In addition, we explored the determinants of financial hardship indicators as a result of hospitalization costs.

Methods

In order to conduct this research, data were extracted from the latest Bangladesh Household Income and Expenditure Survey (HIES), conducted by the Bangladesh Bureau of Statistics in 2016–2017. Financial hardship indicators in UHC were measured by catastrophic health expenditure and distress financing (sale/mortgage, borrowing, and family support). Concentration curves (CC) and indices (CI) were estimated to measure the pattern and severity of inequalities across socio-economic classes. Binary logistic regression models were used to assess the determinants of catastrophic health expenditure and distress financing.

Results

We found that about 26% of households incurred catastrophic health expenditure (CHE) and 58% faced distress financing on hospitalization in Bangladesh. The highest incidence of CHE was for cancer (50%), followed by liver diseases (49.2%), and paralysis (43.6%). The financial hardship indicators in terms of CHE (CI = -0.109) and distress financing (CI = -0.087) were more concentrated among low-income households. Hospital admission to private health facilities, non-communicable diseases, and the presence of chronic patients in households significantly increases the likelihood of higher UHC financial hardship indicators.

Conclusions

The study findings strongly suggest the need for national-level social health security schemes with a particular focus on low-income households, since we identified greater inequalities between low- and high-income households in UHC financial hardship indicators. Regulating the private sector and implementing subsidized healthcare programmes for diseases with high treatment costs, such as cancer, heart disease, liver disease, and kidney disease are also expected to be effective to protect households from financial hardship. Finally, in order to reduce reliance on OOPE, the government should consider increasing its allocations to the health sector.

Reemergence of dengue virus in Bangladesh: Current fatality and the required knowledge

The current fatality of dengue among the Bangladeshi population has drawn the interest of the public health professionals primarily to focus on the environmental, social, and clinical reasoning as well the possible remedies. This year, in 2019, the dengue situation in Bangladesh has appeared with all its dreadful effects leading to the highest death cases due to dengue virus (DENV) infection. According to the Directorate General of Health Services report, this year (2019) the number of DENV-infected people has appeared to be around five times higher (approximately 50,000 cases so far) compared with the last year, 2018 (around 10,000 cases). The present review discussed the current epidemics of dengue infection in Bangladesh as well the possible means of disease curing in terms of general preventive concepts. However, besides the precise treatment of the dengue-affected patients, the knowledge on DENV genome and on the protective immunity against such reemerging disease is essential.

Antibacterial, anthelmintic, and analgesic activities of Piper sylvaticum (Roxb.) leaves and in silico molecular docking and PASS prediction studies of its isolated compounds

Background In the present study, we investigated the antibacterial, anthelmintic, and analgesic activities of methanol extract of P. sylvaticum leaves (MEPSL) in experimental models. Then, computational analysis (in silico molecular docking and PASS prediction) was performed to determine the potent phytoconstituents of total six isolated compounds of this plant for antibacterial and anthelmintic activities. Methods Qualitative and quantitative phytochemical studies were carried out by established methods. In vitro antibacterial activity was determined by disc diffusion technique and anthelmintic activity was tested against Tubifex tubifex worm whereas analgesic activity was determined by the acetic acid-induced writhing test in mice. Molecular docking study was performed using Schrödinger Maestro 10.1 and an online tool used for PASS prediction. Results Our phytochemical study revealed the presence of alkaloids, flavonoids, saponins, and also indicated a substantial amount of phenols (65.83 mg), flavonoids (102.56 mg), and condensed tannins (89.32 mg). MEPSL showed good antibacterial activity against both gram-positive and gram-negative bacteria. Our result exhibited that MEPSL has strong anthelmintic action compared to standard levamisole. In addition, the extract also showed a dose-dependent and statistically significant analgesic activity at the doses of 200 and 400 mg/kg, body weight. Docking studies showed that piperine and piperlonguminine have the best scores for the tested enzymes. PASS predicted the antibacterial and anthelmintic activity of both phytoconstituents. Conclusions This study suggests that MEPSL possess significant antibacterial, anthelmintic, and analgesic activities which could be related to the presence of several phytochemicals. The phytoconstituents, i.e. piperine and piperlonguminine were found to be most effective in computational studies.

Antimicrobial Resistance Profile of Different Clinical Isolates against Third-Generation Cephalosporins

BACKGROUND

Drug resistant microorganisms lead to an increase in morbidity and mortality as they boost the risk of inappropriate therapy. Hence, data on antimicrobial resistance help define the best possible treatment for individual patients. Therefore, this study aimed to screen the antimicrobial resistant profile of 3rd generation cephalosporin drugs in Jimma University Specialized Teaching Hospital.

METHODS

A hospital based prospective cross-sectional study was conducted in Jimma University Specialized Hospital (JUSH) from April to August 2016. The clinical samples such as wound swab, urine, sputum, and stool were collected from hospitalized patients. Then, bacterial species were isolated and identified as per the standard microbiological methods. Antimicrobial susceptibility tests were carried out using various antimicrobial discs by Kirby-Bauer disc diffusion method.

RESULTS

Totally, 248 bacterial isolates were obtained from 154 (62.1%) male and 94 (37.9%) female patients. Escherichia coli (25.4%) and Staphylococcus aureus (19.0 %) were the predominant organisms isolated from specimens. About 140 (56.5%) and 149 (60.1%) of the total bacterial isolates were found to be resistant to ceftriaxone and ceftazidime, respectively. The majority of Escherichia coli isolates 46 (73%) were resistant to ceftriaxone and 41 (65%) of them were resistant to ceftazidime. Staphylococcus aureus, which accounted 19% of the total bacterial isolates, showed 23.4% and 34% resistance to ceftriaxone and ceftazidime, respectively. Among the bacterial strains revealing resistant to ceftriazone and ceftazidime, about 109 (44%) and 108 (43.5%) of them were resistant to two, three, or four other drugs, respectively.

CONCLUSION

Bacterial resistance towards third-generation cephalosporin (ceftriaxone and ceftazidime) is escalating as more than half of the isolated strains demonstrated resistance to these drugs. Moreover, these strains also revealed multidrug resistance mainly against clinically used drugs which could render therapy unsuccessful. Therefore, in clinical use appropriate medications should be selected based on the data obtained from antimicrobial susceptibility tests.

Collaborative Research on Puerperal Infections in Bangladesh

Bangladesh is considered as a high-risk country for emerging infectious diseases because of its high population density, poverty, and unhygienic conditions. Although control efforts have primarily been focused on major infectious diseases such as diarrheal diseases, tuberculosis, malaria, and HIV infection, the prevalence and impact of many local or minor infectious diseases are still unclarified in this country. In this review, we present our recent experience and outcomes of collaborative research on puerperal infection (PI), which is a poorly defined infectious disease in Bangladesh. PI is the most common complication during the perinatal period in developing countries. We investigated the incidence of individual species of aerobic bacteria causing PIs and their drug resistance, and the genetic traits of isolates during the two-year period (2010-2012). The common species of isolates from patients with PIs were Escherichia coli, Enterococcus faecalis, Staphylococcus haemolyticus, Proteus mirabilis, Staphylococcus aureus, and Klebsiella pneumoniae. A remarkable finding was the high rates of resistance to cephalosporins among Gram-negative bacteria harboring extended-spectrum beta-lactamase genes, which were associated with carbapenem resistance in a few isolates. This study defined the importance of control of antimicrobial resistance in Bangladesh, and provided suggestions for the future direction of collaborative research on infectious diseases in Bangladesh.

Prevalence of vancomycin resistant Staphylococcus aureus (VRSA) in methicillin resistant S. aureus (MRSA) strains isolated from burn wound infections

Objectives:

The increase in resistance of methicillin resistant Staphylococcus aureus (MRSA) strains to vancomycin has been perceived as a formidable threat in the therapeutic fields. The present study investigated the vancomycin resistance traits of MRSA isolates [vancomycin resistant S. aureus (VRSA)] collected from burn patients.

Materials and Methods:

Twenty-nine of 40 isolates of Staphylococcus spp. were identified as S. aureus which were further tested against 20 commercially available antibiotics to determine antibiotic susceptibility patterns.

Results:

Imipenem was the most potential antibiotic resulting in 90% sensitivity, followed by netilmicin, clindamycin, and nitrofurantoin (80% sensitivity). All isolates were found to be resistant to penicillin. Approximately 75% of them were found to be resistant to methicillin, oxacillin, azithromycin, cipro-floxacin, and tetracycline. Approximately 45% isolates exhibited resistance to amikacin, chloramphenicol, gentamycin, and tobramycin. Twenty-one of the 29 strains of S. aureus were MRSA, of which 11 were resistant to vancomycin when employing the disc diffusion method. However, when the broth micro-dilution procedure was used to measure the minimum inhibitory concentration (MIC) of vancomycin, eight isolates were resistant to vancomycin, six with an MIC of 32 μg/mL and two with an MIC of 64 μg/mL.

Conclusion:

A significant fraction of VRSA was found among MRSA strains in this study, revealing the necessity for new and effective drugs against MRSA.

Safe usage of cosmetics in Bangladesh: a quality perspective based on microbiological attributes

The present review attempted to emphasize on the microbiological quality of the commonly used cosmetics item by the majority of the Bangladeshi community. The abundance of contaminating microorganisms has been quantitatively discussed and the possible health risk has been focused upon usage of these items. Only a very few research efforts have been conducted on the cosmetic items in Bangladesh so far. The microbiological contamination aspects have been portrayed in this review using the information collected from a substantial number of cosmetic items which were earlier subjected to extensive microbiological and biochemical analyses. The prevalence of bacteria, fungi and the specific pathogenic microorganisms has been discussed based on research so far locally conducted on the finished items sold in markets, especially within the Dhaka metropolis. The laboratory scale experiments revealed the presence of enormous number of bacteria, actinomycetes and fungi within the commonly used cosmetics. Conversely, the anti-bacterial activity was noticed in some of the products which might be in favor of the user safety. The prevalence of pathogenic microorganisms in the cosmetic items certainly raises a substantial public health issue. The necessity of the routine microbiological testing of the commonly used cosmetic items as well as the legislative measures to mitigate the contamination problem is thus of great significance.